A mindful practice

One by one the institutions of our State have come under attack in recent years. Some have been found to be morally bankrupt, others are financially bankrupt and even more are both morally and financially bankrupt. Our health system seems to be in a constant state of flux and now, with a lot of focus on our primary-care services, attention turns to GPs.

A recent editorial in this newspaper acknowledged that general practice is struggling to provide a safe and quality service to patients. Recent cuts in grants that fund equipment and employment of practice nurses were met with frustration among GPs. Now, the proposed introduction of free GP care for under-sixes is coming at a time when many GPs are seeing discretionary medical cards withdrawn from vulnerable patients.

How are GPs coping with the stresses and strains of their jobs? How can they face daily queues of sick patients and the possibility of even busier surgeries, if universal family doctor care is introduced, without having equipment and staff to manage their patient lists?

Personal stresses
The self-care of GPs is rarely discussed in public. "General practice is a stressful career. I am at it 30 years, and I'm passionate about it, but there are personal stresses – especially for young GPs with families – and stresses transferred across from your patients. You hear very sad stories," says Dr Rita Doyle, a GP in Bray, Co Wicklow, and former president of the Irish College of General Practitioners (ICGP).

Doyle says that because of patient confidentially, GPs rarely have the opportunity to debrief, following the stresses of the day.

“I train young GPs and I strongly believe ethics and self-care have to be taught at every level of training: undergraduate, post- graduate and continuous medical training.

“I’m also the ICGP representative on the Medical Council and we see doctors with health issues that wouldn’t have become so serious if they had been picked up earlier.”

Dr Andrée Rochfort is in charge of the ICGP’s Health in Practice programme, and says: “The aim of the programme is to promote good physical, psychological and occupational health for GPs. There is a lack of recognition that doctors themselves have healthcare needs.

“We are led to believe that we are immune to illness. We often sweep it under the carpet in case it intrudes with our level of care. We have never been trained to look after ourselves.”

For these reasons, the ICGP has a list of 150 healthcare practitioners – GPs, psychologists and occupational physicians – to whom GPs can self-direct.

“We also promote courses in cognitive behaviour therapy, yoga, mindfulness for GPs, mental health and have an information helpline that GPs, their families or staff in their practice can call if they are concerned about the health of a GP.”

Stress-reduction course
Today, at a conference in Dublin Castle, Dr Ming Rawat will talk about a course in mindfulness-based stress reduction (MBSR) that she runs for trainee GPs in north Dublin.

These courses have been widely used in Australia and North America as part of self-care programmes for doctors. At the same conference, psychotherapist Debbie Correll will speak about a MBSR course tailored for GPs in Ireland.

“I think there is growing awareness of the alarming level of burnout among GPs and, with the implosion of institutions in this country, patients are coming into their GPs with high levels of emotional stress, which brings a big strain on GPs,” according to Correll.

“When you are distracted and stressed, you can’t listen to patients beyond a list of symptoms.

“Mindfulness [meditation] helps you reconnect with the meaning of being a GP. This gives doctors more chance of acting with clarity and integrity so that they can see things as they are and respond, rather than react or work on auto-pilot,” says Correll.

“Good communication, according to Correll, is built on resonance. “It’s about intuition and picking up on nonverbal signals. The aim of these courses is not to treat or cure burnout, but to prevent it.”

Correll says that, like anyone else, doctors can access mindfulness courses, but a key advantage for them in doing a course in mindfulness with other GPs is that they can share their experiences within the group.

“GPs can be very isolated. The peer-support model is not a formal part of their practice, unlike in psychotherapy, for example,” where she says clinical supervision could be accessed in the practice.

Dr Rita Doyle is an advocate of mindfulness meditation. She did an eight-week MBSR course a number of years ago and recommends it to many of her patients.

“The evidence for MBSR courses in medical journals has got much stronger. Patients who have done courses in mindfulness have told me afterwards that they were life-transforming.

“The thing with mindfulness is that once you get it [the concept that you can observe your thoughts and learn to respond rather than react to situations/events], you have it for the rest of your life.”

Debbie Correll and Dr Ming Rawat will speak about GPs' wellbeing at The Art of Being Still conference in Dublin Castle today. See sanctuary.ie

See icgp.ie for information about the GPs Health in Practice programme. The helpline for GPs with health problems is 087-7519307.